Patient Care Coordination Research Articles

“But at home, with the midwife, you are a person”: experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations

BackgroundPostpartum home-based midwifery care is covered by basic health insurance in Switzerland for all families with newborns but must be self-organized. To ensure access for all, Familystart, a network of self-employed midwives, launched a new care model in 2012 by ensuring the transition from hospital to home through cooperation with maternity hospitals in the Basel area. It has particularly improved the access to follow-up care for families in vulnerable situations needing support beyond basic services. In 2018, the SORGSAM (Support at the Start of Life) project was initiated by Familystart to enhance parental resources for better postpartum health outcomes for mothers and children through offering improved assistance to psychosocially and economically disadvantaged families. First, midwives have access to first-line telephone support to discuss challenging situations and required actions. Second, the SORGSAM hardship fund provides financial compensation to midwives for services not covered by basic health insurance. Third, women receive financial emergency support from the hardship fund.AimThe aim was to explore how women living in vulnerable family situations experienced the new early postpartum home-based midwifery care model provided in the context of the SORGSAM project, and how they experienced its impact.MethodsFindings are reported from the qualitative part of the mixed-methods evaluation of the SORGSAM project. They are based on the results of seven semi-structured interviews with women who, due to a vulnerable family postpartum situation at home, received the SORGSAM support. Data were analyzed following thematic analysis.ResultsInterviewed women experienced the early postpartum care at home, as “relieving and strengthening” in that midwives coordinated patient care that opened up access to appropriate community-based support services. The mothers expressed that they felt a reduction in stress, an increase in resilience, enhanced mothering skills, and greater parental resources. These were attributed to familiar and trusting relationships with their midwives where participants acknowledged deep gratitude.ConclusionThe findings show the high acceptance of the new early postpartum midwifery care model. These indicate how such a care model can improve the well-being of women in vulnerable family situations and may prevent early chronic stress in children.

Exploring interprofessional communication and collaboration among pharmacists, nurses, and laboratories enhancing patient safety and healthcare outcomes

Background: The efficiency of healthcare delivery is closely connected to the quality of interprofessional communication and cooperation among healthcare workers. The purpose of this research is to examine the diverse effects of interprofessional cooperation including pharmacists, nurses, and laboratory experts on patient safety and healthcare outcomes. Aim: This extensive study aims to consolidate current literature, empirical data, and theoretical models to provide a clear comprehension of the importance of efficient interprofessional communication and cooperation in healthcare environments. The objective of the evaluation is to assess the influence of cohesive teamwork, communication, and cooperation among healthcare professionals on several aspects of healthcare, including patient safety, medication management, care coordination, diagnostic accuracy, and overall healthcare quality. Method: A methodical search technique was used to locate relevant studies in electronic databases, such as PubMed, MEDLINE, and Cochrane Library. The inclusion criteria include research that provide insights into the influence of interprofessional cooperation on patient safety, healthcare outcomes, and the involvement of pharmacists, nurses, and laboratory experts in improving healthcare delivery. Results: The analysis emphasizes the crucial significance of pharmacists, nurses, and laboratory experts in improving patient safety and healthcare results by means of efficient interprofessional communication and cooperation. T

Identifying Individual and Clinic Characteristics Associated With Primary Care Provider Turnover During Implementation of the Veterans Health Administration Patient-Centered Medical Home.

Understanding which factors predict primary care provider (PCP) turnover can help organizations prepare for PCP shortages. We conducted a retrospective cohort study of Veteran Health Administration PCPs between 2012 and 2016. We analyzed whether 7 domains of the patient centered medical home (PCMH) implementation-including access, care coordination, comprehensiveness, self-management support, communication, shared decision-making, and team-based care-were associated with PCP turnover. We found that 2 domains of PCMH (access and self-management) were associated with lower turnover, which may reflect that practice cultures that support these characteristics may lower PCP turnover.

Online industry resources can help ensure continuity of care for patients on long-acting injectable antipsychotics while traveling or relocating.

Dear Editor:These authors read with interest the recent psychopharmacology pearls published in the journal. In the update on long-acting injectable antipsychotics (LAIA), Case 4 is about a fictional patient, B.B., who is diagnosed with schizophrenia and stabilized on paliperidone 3-month injectable 546 mg for 3 years.1 B.B. misses a dose of their paliperidone injection because of relocating to a different state and having subsequent delays in establishing psychiatric care. A discussion then follows about the management of missed doses of LAIAs.Although the case is fictional, it describes a real situation that clinicians may very well encounter in their practice. We would like to point out that Alkermes, Otsuka, and Janssen offer online resources that enable patients or their practitioners to find providers who can administer LAIAs thereby preventing disruptions in therapy like the one in the case described.2-4 To our knowledge, the olanzapine LAIA and risperidone subcutaneous LAIA do not offer this level of support. Readers may find the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Services Locator helpful when coordinating care for patients treated with these products.5 For all other LAIAs, Table 1 lists the drug name and the corresponding websites that can help find providers who can administer them. These online search tools help locate care centers that have staff who are experienced with the safe administration of LAIAs. In states where pharmacists are legally allowed to administer LAIAs, care centers include retail pharmacies, and in states where this is not legally permitted, outpatient clinics, doctors' offices, and urgent care facilities may serve as care centers. These resources can be used well in advance of the patient's planned trip or relocation and can assist in maintaining continuity of care even before the patient is able to establish long-term psychiatric care. In some cases, reimbursement may be available from the pharmaceutical company for coordinating the patient's care.Since 2018, our office has served as a local care center for patients treated with aripiprazole monohydrate LAIA. Since that time, we've provided injections for patients diagnosed with schizophrenia or bipolar 1 disorder who are traveling to our region, relocating, or having trouble establishing mental health care.We hope to boost awareness of these valuable industry-enabled resources that can and should be used to help avoid disruptions in therapy that can be costly and all too often precede decompensation like in the case described. We should applaud our industry partners for offering these tools that assist with coordinating patient care and help individuals with mental illness lead more normal lives.

MP22-08 PREDICTORS OF TRAVEL DISTANCE FOR RADICAL CYSTECTOMY IN FLORIDA: IMPLICATIONS FOR ACCESS TO CARE

You have accessJournal of UrologyCME1 Apr 2023MP22-08 PREDICTORS OF TRAVEL DISTANCE FOR RADICAL CYSTECTOMY IN FLORIDA: IMPLICATIONS FOR ACCESS TO CARE Jared Schommer, Shalmali Borkar, Emily Brennan, Andrew Zganjar, Dorin Colibaseanu, Aaron Spaulding, and Timothy Lyon Jared SchommerJared Schommer More articles by this author , Shalmali BorkarShalmali Borkar More articles by this author , Emily BrennanEmily Brennan More articles by this author , Andrew ZganjarAndrew Zganjar More articles by this author , Dorin ColibaseanuDorin Colibaseanu More articles by this author , Aaron SpauldingAaron Spaulding More articles by this author , and Timothy LyonTimothy Lyon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Travel distance to a center performing radical cystectomy (RC) is a well-established risk factor for impaired access to care and care fragmentation. However, the characteristics associated with increased travel for RC remain incompletely defined but are needed to inform efforts to bridge these gaps in care. The objective of this study was to assess features associated with travel distance for RC in a statewide dataset. METHODS: The Florida Inpatient Discharge Database was used to identify RC patients from 2013-2019. Travel distance was estimated using zip code centroids and modeled as < 25 miles, 25-50 miles, or > 50 miles. The primary outcome was travel >50 miles for RC. Secondary outcomes included inpatient mortality, discharge to a non-home facility, inpatient complications, and characteristics of hospitals that were bypassed by those traveling. U.S. County Health Rankings were included as model covariates and analyzed by tertile. Mixed effects logistic regression models accounting for clustering within hospitals were utilized. RESULTS: We identified 4209 patients, of whom 2284 (54%) traveled <25 miles, 654 (16%) traveled 25-50 miles, and 1271 (30%) traveled >50 miles. Travel distance >50 miles was associated with treatment at a high-volume center and significantly lower risks of inpatient mortality, non-home discharge, and postoperative complications (all P<0.02). Bypassed hospitals were less likely to be teaching facilities (56% vs. 96%, P<0.001) and more likely to perform ≤5 RC/year (75% vs. 25%, P<0.001). Following multivariable adjustment, patients who traveled >50 miles were significantly younger (OR 0.98, 95% CI 0.97-1.00), less likely to be Hispanic/Latino (OR 0.35, 95% CI 0.23-0.51), and more likely to reside in a county with the lowest health behavior ranking (OR 6.48, 95% 3.81-11.2) and lowest social economic ranking (OR 7.63, 95% CI 5.30-11.1) compared to those who traveled <25 miles (all P<0.01). Patients who traveled >50 miles primarily lived in central, southeast, or southwest Florida. CONCLUSIONS: In Florida, digital outreach aimed to improve care coordination for RC patients would be best targeted in counties with low health behavior and social economic rankings in central and southern Florida. Further work is needed to understand why Hispanic/Latino patients were least likely to travel outside of their local community for RC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e299 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jared Schommer More articles by this author Shalmali Borkar More articles by this author Emily Brennan More articles by this author Andrew Zganjar More articles by this author Dorin Colibaseanu More articles by this author Aaron Spaulding More articles by this author Timothy Lyon More articles by this author Expand All Advertisement PDF downloadLoading ...

Community Health Representative Workforce: Integration across systems and teams to address the social determinants of indigenous health and wellbeing.

Tribally employed, Community Health Representatives (CHRs) serving Indigenous and American Indian and Alaskan Native (AIAN) peoples are culturally and linguistically embedded community leaders, with the unique ability to serve as the link and intermediary between community members and systems. Unique to the CHR workforce scope of practice is the expectation for high level integration within the medical and social service care team. This explicit role outlined in the scope of work sets an expectation for both CHR and care teams to deliver integrated patient, family, and systems level care coordination and case management. This paper aims to build from our previous manuscript published in Volume 1 of the special issue Community Health Workers Practice from Recruitment to Integration. In that Volume, we explored through a Community Case Study CHR Managers' perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving AIAN. In this paper, we offer new information about the current CHR and CHR Managers' involvements and perceived level of integration within health care teams and the broader public health systems addressing the social and structural determinants of health. We approach this topic considering the COVID-19 pandemic and how CHRs and CHR Programs were included and not included in tribal pandemic response efforts.

Coordinated Patient Care via Mobile Phone-Based Telemedicine in Secondary Stroke Prevention: A Propensity Score-Matched Cohort Study.

To prevent recurrent stroke, patients need to follow evidence-based practices following discharge; however, adherence to these practices is suboptimal. To evaluate whether a smartphone mobile application can improve medication adherence and stroke awareness in secondary stroke prevention. A retrospective study design was used. Patients with ischemic stroke registered in a database between August 2018 and January 2019 were enrolled. Propensity score matching was used to match patients managed with the mobile application compared with regular practice in a 1:2 ratio. Sixty-five patients were paired with 123 controls. Three-month medication adherence was 93.8% in the application group versus 82.9% in the control group ( P = .036). Patients in the application group were more likely to know stroke warning signs ( P = .003) and when to call an ambulance for stroke symptoms (87.7% vs 72.4%, P = .016). Using a mobile application may increase medication adherence and stroke awareness in secondary stroke prevention.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Implementation and operationalization of Integrated People-Centred Health Services delivery strategies in integrated osteoporosis care (IOC) initiatives: a systematic review.

Integrated Osteoporosis Care (IOC) has been emerging over the past decade. To support integrated careinitiatives, the World Health Organisation (WHO) has developed the Integrated People Centred Health Services(IPCHS) framework, which consists of five interdependent strategies. Five electronic databases (PubMed, Embase, World of Science, CINAHL, and Scopus) were searched for relevant studies published from January 1, 2010 to December 2022. Initiatives implementing collaborative practices and at least two IPCHS strategies were included. Quality assessment was performed using the Effective Public Health Practice Project checklist. Seventy-six publications describing 69 implementations met the inclusion criteria; 90% of them were implemented at the hospital level, and over half focused on secondary fracture prevention. Three implementations captured all five IPCHS strategies, and half applied three. Substrategies targeting individuals as beneficiaries were frequently employed. Substrategies requiring fundamental shifts (e.g., systemic coordination and updating) were seldomly implemented. Substantive heterogeneity in substrategy operationalization was observed. Patient education, standardized care, team-based care, care coordinators, and health care provider training were commonly pursued. IOC interventions have focused mainly on secondary fracture prevention in a hospital setting and have been narrowly operationalized. Future implementation should: employ all five IPCHS strategies; better align programmes, providers, and regulatory frameworks, while adapting funding mechanisms; and operationalize broader and more innovative substrategies.Registration: This review has been registered at the international prospective register of systematic reviews PROSPERO (CRD42021250244).

What's New in Hand and Wrist Surgery.

What's New in Hand and Wrist Surgery.

Healthcare professionals’ perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital: A qualitative comparative study of two Nordic capitals

BackgroundThe handover of older adults with complex health and social care from hospital admissions to homebased healthcare requires coordination between multiple care providers. Providing insight to the care coordination from healthcare professionals’ views is crucial to show what efforts are needed to manage patient handovers from hospitals to home care, and to identify strengths and weaknesses of the care systems in which they operate.ObjectiveThis is a comparative study aiming to examine healthcare professionals’ perceptions on barriers and facilitators for care coordination for older patients with complex health and social care needs being discharged from hospital in two capital cities Copenhagen (DK) and Stockholm (SE).MethodSemi-structured interviews were conducted with 25 nurses and 2 assistant nurses involved in the coordination of the discharge process at hospitals or in the home healthcare services (Copenhagen n = 11, Stockholm n = 16). The interview guide included questions on the participants’ contributions, responsibilities, and influence on decisions during the discharge process. They were also asked about collaboration and interaction with other professionals involved in the process. The data was analysed using thematic analysis.ResultsMain themes were communication ways, organisational structures, and supplementary work by staff. We found that there were differences in the organisational structure of the two care systems in relation to integration between different actors and differences in accessibility to patient information, which influenced the coordination. Municipal discharge coordinators visiting patients at the hospital before discharge and the follow-home nurse were seen as facilitators in Copenhagen. In Stockholm the shared information system with access to patient records were lifted as a facilitator for coordination. Difficulties accessing collaborators were experienced in both settings. We also found that participants in both settings to a high degree engage in work tasks outside of their responsibilities to ensure patient safety.ConclusionsThere are lessons to be learned from both care systems. The written e-communication between hospitals and home health care runs more smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there are more sector-overlapping work which might secure a safer transition from hospital to home. Participants in both settings initiated own actions to weigh out imperfections of the system.

Leveraging Decentralized Autonomous Organizations in Healthcare to Coordinate Precision Level Patient Care

The healthcare system is expensive, inefficient and frustrating due to unnecessary third parties and friction filled manual processes that get between patients and their doctors. Through decentralized identityby and credentialing we can create a distributed network of practicing doctors that connect connect securely, directly, privately with each other and with the patients they care for. We are building the future essentialized healthcare revolution and we can’t wait to build it with you.

Experiencing COVID-19, home isolation and primary health care: A mixed-methods study.

Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8%; 95.2%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8%; 15.5%, P < 0.001), telephone consultation remained the main mode of consultation (78.5%) and video remained insignificant (1.9%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.

Scribes with PGY-1 Residents on Inpatient Medicine Teams: Effect on Time Spent in Meaningful Work.

The high documentation demands and limited time in direct patient care in the first year of internal medicine residency represent concerns for burnout and low job satisfaction in this important year of training. To assess the effect of scribes on the time PGY-1 residents spent on various work tasks. Participants were 24 PGY-1 internal medicine residents on two inpatient medicine teams at one site for 6 months (September 2019-February 2020). Residents were assigned a scribe during the first or second 2 weeks of a 4-week rotation and had no scribe for the other 2 weeks. Time study observers documented resident work activities. Residents ranked the meaningfulness of work activities via survey at the end of each 2-week period. Of 24 residents, 18 (75%) completed the survey at both time points. Residents ranked patient care as the most meaningful and EHR work as the least meaningful work activity. EHR work claimed the largest percentage of time, with or without a scribe (mean, 33.2% and 39%, respectively). With a scribe, residents spent significantly less time (-5.8%, P < 0.0001) in EHR work and significantly more time (1.3%, P = 0.0267) in direct patient care and coordinating patient care (3.0%, P < 0.0001). The presence of a scribe with PGY-1 internal medicine residents on inpatient teams resulted in a significantly greater percentage of total work time spent in work they considered most meaningful and a significantly lower percentage of total work time in work they considered least meaningful.

Critical Care Flight Nurses' role within secondary aeromedical services and the inter-hospital transfer of patients with acute spinal cord impairment

Aim: To highlight the role of secondary aeromedical services and required knowledge of Critical Care Flight Nurses (CCFN), in facilitating the safe inter-hospital transfer of patients with acute Spinal Cord Impairment (SCI) from a Major Trauma Centre (MTC) to a specialist SCI centre. Method: Literature search. Results: There is significant demand for secondary aeromedical services in order for patients with acute SCI to be transferred to a SCI centre within 24 h of injury. CCFN play an important role in triaging patients, coordinating patient care, arranging logistics of transport as well as providing direct clinical care inflight. CCFN must have knowledge regarding the pathophysiology of acute SCI, altitude physiology and interventions to manage stressors of flight in the aeromedical environment. Specific clinical challenges encountered by CCFN include the prevention of hypobaric hypoxic hypoxia and achieving appropriate immobilisation of the spine. Conclusion: Mitigating the increased risk associated with transporting critically unwell patients with SCI in the aeromedical environment, relies on aeromedical clinicians with education and training within the clinical specialty of aeromedical retrieval. The availability of secondary aeromedical services to undertake urgent inter-hospital retrieval of patients with acute SCI will be promoted by the continued development of Retrieval Nurse Practitioner (RNP) roles.

Automatic Classification of Tumor Response From Radiology Reports With Rule-Based Natural Language Processing Integrated Into the Clinical Oncology Workflow.

Imaging reports in oncology provide critical information about the disease evolution that should be timely shared to tailor the clinical decision making and care coordination of patients with advanced cancer. However, tumor response stays unstructured in free-text and underexploited. Natural language processing (NLP) methods can help provide this critical information into the electronic health records (EHR) in real time to assist health care workers. A rule-based algorithm was developed using SAS tools to automatically extract and categorize tumor response within progression or no progression categories. 2,970 magnetic resonance imaging, computed tomography scan, and positron emission tomography French reports were extracted from the EHR of a large comprehensive cancer center to build a 2,637-document training set and a 603-document validation set. The model was also tested on 189 imaging reports from 46 different radiology centers. A tumor dashboard was created in the EHR using the Timeline tool of the vis.js javascript library. An NLP methodology was applied to create an ontology of radiographic terms defining tumor response, mapping text to five main concepts, and application decision rules on the basis of clinical practice RECIST guidelines. The model achieved an overall accuracy of 0.88 (ranging from 0.87 to 0.94), with similar performance on both progression and no progression classification. The overall accuracy was 0.82 on reports from different radiology centers. Data were visualized and organized in a dynamic tumor response timeline. This tool was deployed successfully at our institution both retrospectively and prospectively as part of an automatic pipeline to screen reports and classify tumor response in real time for all metastatic patients. Our approach provides an NLP-based framework to structure and classify tumor response from the EHR and integrate tumor response classification into the clinical oncology workflow.

Role of digital health in coordinating patient care in a hub-and-spoke hierarchy of cancer care facilities: a scoping review.

Coordinating cancer care is complicated due to the involvement of multiple service providers which often leads to fragmentation. The evolution of digital health has led to the development of technology-enabled models of healthcare delivery. This scoping review provides a comprehensive summary of the use of digital health in coordinating cancer care via hub-and-spoke models. A scoping review of the literature was undertaken using the framework developed by Arksey and O'Malley. Research articles published between 2010 and 2022 were retrieved from four electronic databases (PubMed/MEDLINE, Web of Sciences, Cochrane Reviews and Global Health Library). The preferred reporting items for systematic reviews and meta-analyses extension for the scoping reviews (PRISMA-ScR) checklist were followed to present the findings. In total, 311 articles were found of which 7 studies that met the inclusion criteria were included. The use of videoconferencing was predominant across all the studies. The number of spokes varied across the studies ranging from 1 to 63. Three studies aimed to evaluate the impact on access to cancer care among patients, two studies were related to capacity building of the health care workers at the spoke sites, one study was based on a peer review of radiotherapy plans, and one study was related to risk assessment and patient navigation. The introduction of digital health led to reduced travel time and waiting period for patients, and standardisation of radiotherapy plans at spokes. Tele-mentoring intervention aimed at capacity-building resulted in higher confidence and increased knowledge among the spoke learners. There is limited evidence for the role of digital health in the hub-and-spoke design. Although all the studies have highlighted the digital components being used to coordinate care, the bottlenecks, Which were overcome during the implementation of the interventions and the impact on cancer outcomes, need to be rigorously analysed.

Telemonitoring for health education and self-management in South Western Sydney.

Telemonitoring (TM) plays an important role in the self-management of chronic diseases. This study aimed to assess the feasibility of TM in early stages of chronic care for self-management and recognition of signs and symptoms of exacerbation, with a view to completing the TM program in an optimal timeframe to encourage independence and self-management. This study was conducted from 2019 to 2020. Included in the study were patients with chronic conditions at an early stage of their disease residing in the South Western Sydney region. Eligible patients were allocated a TM device for 6months. Their routine tests data were sent in real time to health care professionals. Following assessment by a TM coordinator, suitable patients were off-boarded (deactivation of monitoring device) after 6months. Data on hospitalisation/emergency department presentation and surveys were collected to assess the impact of TM on the level of the patient's understanding of their signs and symptoms of exacerbation, self-care, and quality of life. Out of 44 patients approached, seven were off-boarded at the 6-month timeframe. The follow-up data on the hospitalisation/emergency department presentation during monitoring and 12months post off-boarding showed a reduction in the frequency of hospitalisation/nil admissions. Patients reported an increased understanding of their health condition and confidence in managing their own health with the support of TM. The result demonstrates the feasibility of TM as a tool for health education and self-management in the coordination of care for chronic disease patients; however, the small sample size was a limitation.

Establishing a state-wide pelvic exenteration multidisciplinary team meeting in South Australia.

Pelvic exenteration surgery is complex, necessitating co-ordinated multidisciplinary input and improved referral pathways. A state-wide pelvic exenteration multidisciplinary team (MDT) meeting was established in SA and the outcomes of this were audited and compared with historical data. All patients referred for discussion between August 2021 and July 2022 to the SA State-wide Pelvic Exenteration MDT were included in this study. MDT discussion centred around disease resectability, risk versus benefit of surgery, and need for local or interstate referral. Prospective data collection included patient demographics and MDT recommendations of surgery, palliation, or referral. Patients referred for surgery locally or interstate were compared with a retrospective patient cohort treated previously between January and December 2020. Over 12 months, 91 patients were discussed (including nine multiple times), by a mean of 18 meeting participants each month. Forty-eight patients (58.5%) had primary malignancy, 25 (30.5%) recurrent malignancy, and 9 (11.0%) had non-malignant disease. Colorectal cancer was the most common presentation (56.1%), followed by gynaecological (30.5%) and urological (6.1%) malignancy. Pelvic exenteration surgery was recommended to be performed locally in 53.7% of patients and the remainder for non-surgical treatment, palliation, or re-discussion. During this time, 44 patients underwent surgery locally (versus 34 in 2020) and only 4 referred interstate (versus 8 in 2020). The establishment of a dedicated state-wide pelvic exenteration MDT has resulted in better coordination of care for patients with locally advanced pelvic malignancy in SA, and significantly reduced the need for interstate referral.

1019. The Future is Embedded in the Present - Characterizing Pharmacist Interventions in an Infectious Diseases Clinic

Abstract Background Incorporating clinical pharmacists into the outpatient care setting can improve patient outcomes; however, the focus has mostly been on primary care. In 2021, Ascension Specialty Pharmacy embedded clinical pharmacists into clinics prescribing specialty medications to increase prescription capture and improve patient care. The clinical pharmacist incorporated into the Ascension St. John Infectious Diseases clinic provides patient outreach, care coordination, financial and prior authorization assistance, medication reconciliation and counseling, and clinical interventions. This study characterizes the pharmacist interventions provided during a six month timeframe. Methods As of September 2021, the clinical pharmacist’s interventions were consistently captured in a documentation system. Each patient encounter that resulted in one or more interventions were entered as one documentation event, which captures type of problem, recommendation category, intervention acceptance, and estimated time spent. If more than one problem within the same type occurred on a patient, it could only be recorded as one problem. A report was pulled over a six month period of September 2021 through February 2022. Results During the timeframe reported, infectious disease specialty prescriptions filled at Ascension Specialty Pharmacy had nearly doubled from before embedding the pharmacist (monthly average, 115 vs. 66). During the study period, 316 patient encounters resulted in clinical pharmacist interventions, which included 594 problem types. The frequency of problem types included under-treatment (32%), medication monitoring needed (28%), suboptimal drug (18%), sub-optimal dosing/duration/frequency/administration (12.52%), nonadherence (5.92%), and adverse drug event (4.74%). Pharmacist interventions were accepted 90% by physicians and 81% by patients. The pharmacist time spent on interventions was estimated at 203 hours during the study period. Conclusion Despite limitations in how interventions are documented and reported, this study demonstrates the significant impact a clinical pharmacist embedded into an infectious diseases clinic can have on optimizing patient care. Disclosures Shawn Depcinski, PharmD, bioMérieux: Honoraria.